Provider Demographics
NPI:1679071724
Name:ZEISS, ELISA JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:JEAN
Last Name:ZEISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WYMORE
Mailing Address - State:NE
Mailing Address - Zip Code:68466-1721
Mailing Address - Country:US
Mailing Address - Phone:402-239-7849
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 310
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640-0310
Practice Address - Country:US
Practice Address - Phone:402-993-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2195363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical